Double-Chamber Left Atrium After Mitral Valve Surgery

Abstract

A 44-YEAR-OLD woman (height 158 cm, weight 62 kg) presented with shortness of breath on mild exertion of several months duration. An electrocardiogram indicated the presence of atrial fibrillation with a ventricular rate of 80 to 100/min. Transthoracic echocardiography revealed severe mitral stenosis with an enlarged left atrium. The patient was scheduled for mitral valve replacement surgery. After induction of anesthesia, transesophageal echocardiography (TEE) confirmed the previous findings and demonstrated layered thrombus in the left atrium along the atrial septum. The mitral valve was approached transseptally, and the layered thrombus along the left atrial wall was excised. The mitral valve was replaced with a bioprosthetic mitral valve (Epic, 27 mm; Abbott, Chicago, IL). After the patient was separated from cardiopulmonary bypass, repeat TEE demonstrated an apparent “double chamber” in the left atrium (Fig 1, Fig 2; Videos 1 and 2). What is the diagnosis? Fig 2Transesophageal echocardiography midesophageal long-axis view showing a septumlike shadow inside left atrium. View Large Image Figure Viewer Download Hi-res image